This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, December 06, 2014

Weekly Overseas Health IT Links - 06th December, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

The cloud is being widely adopted for applications important to business success, according to a new study by Forrester Research conducted on behalf of Infosys, a provider of consulting and outsourcing services.

A large majority of the 300 organizations in the United States, United Kingdom, Germany, France and Australia surveyed by Forrester in July and August, 2014 (81 percent) said they’re either using or planning to use critical apps in the cloud in the next two years.

The survey found that cost savings is no longer the primary driver for leveraging cloud services, with 77% of organizations considering agility to be the key driver.

Cambridge University Hospital NHS Foundation Trust was forced to declare a “major incident” and divert ambulances to other hospitals for five hours after its new electronic patient record became unstable a week after go-live.

The trust has also had “significant problems” with its pathology system, with problems matching test results to patients. It has asked GPs to stop all routine blood tests at short notice.

The trust says most of the problems reported by its local clinical commissioning group occurred shortly after go-live and are being addressed.

In 2015, hospitals will – and should – make more advanced use of "third platform" technologies based on mobile tools, social channels, data analytics and the cloud, according to a recent report from IDC Health Insights.

With healthcare costs unsustainable, but these new technologies now ubiquitous, IDC officials say hospital CIOs will increasingly be turning to new tools – especially as consumers expect healthcare to be as responsive to their wants and needs as other industries.

Meanwhile, cybersecurity concerns, care coordination and patient engagement will continue to be top concerns, spurring new approaches to IT as hospitals develop increasingly sophisticated digital strategies to improve care quality, broaden access and drive efficiency.

Despite an increase in health data collection, barriers remain to gaining and using the information to improve care, according to a study from the University of Pittsburgh Graduate School of Public Health.

Those barriers hamper decision-making efforts and hurt attempts to tackle global health threats, according to the analysis, published in BMC Public Health and funded by the Bill & Melinda Gates Foundation and the National Institutes of Health.

Eight CIOs met to discuss healthcare security issues and what they can do to best mitigate cybersecurity risks.

Healthcare CIOs admit that it’s not a matter of if their health systems will be breached, it is a question of when their healthcare security systems will be attacked. That was one of several issues discussed by healthcare leaders at the second annual Scottsdale Institute CIO Summit earlier this year.

A Summit report explained strategies that can be used to address emerging informatics requirements for the nation’s healthcare systems. However, finding the best ways to protect against cyber criminals and other health data attacks was a common area of concern among the eight CIOs who attended the summit.

Tennessee-based Community Health Systems (CHS) disclosed in its Form 8-K SEC filing in August that its computer network had been hacked at least twice in April and June of 2014 through criminal cyber attacks originating from China. All healthcare organizations can learn from one health system's breach.

CHS -- which owns, operates, and leases 206 hospitals across 29 different states -- confirmed that these hacking incidents resulted in the theft of non-medical, patient-identifying information of 4.5 million individuals who had, in the last five years, been referred to or received services from physicians affiliated with CHS. This information included patient names, addresses, birthdates, telephone numbers, and social security numbers.

Although CHS portrays the attacks as incidents in which hackers used highly sophisticated malware and technology to attack its system -- and were thereby able to bypass its security measures to access the personal data of millions of patients -- sources closer to the investigation have described a different scenario. According to these sources, CHS's system was hacked through a test server that was never intended to be connected to the Internet at all. Because Internet connectivity was not contemplated, the security features that would -- and should -- be deployed in a live production server were not installed on the test server.

If implemented well, technology can do great things for healthcare, but providers can't let it dictate how to do their work, says Institute for Healthcare Improvement Executive Director Frank Federico.

"We can't let use of technology unintentionally harm patients because we didn't anticipate the possibility that harm could occur and put safeguards in place to mitigate it," he said in a recent interview.

Teaching hospitals can provide the resources and environment needed to effectively test out digital innovations and bring them to market, according to an article at Harvard Business Review.

Digital innovators need to try out their ideas in real-world settings, something teaching hospitals are uniquely positioned to provide, according to authors Louis A. Shapiro, president and CEO of Hospital for Special Surgery in New York City, and C. Mark Angelo, the hospital's vice president of innovation and business development.

They point to a system developed at the hospital to reduce waste in the process of sizing orthopedic implants to the patient. If the implant is opened, but the wrong size, it's discarded, leading to substantial waste. And multiple components from different manufacturers can be confusing as well.

Scott Mace, for HealthLeaders Media , November 25, 2014

This article appears in the November 2014 issue of HealthLeaders magazine.

The next generation of decision-support technology leverages natural language processing (NLP)and continues to evolve by scouring unstructured text and presenting evidence-based medicine to providers in new, accessible, and interesting ways.

In two of the latest examples, clinicians themselves contribute via a growing set of predefined queries, as evidenced by Partner HealthCare's use of QPID, a queriable patient inference dossier technology recently spun out into its own Boston-based company; as well as threaded, Facebook-like conversations behind the firewall, as epitomized by the Mayo Clinic's recent six-month pilot test of Dabo, a technology developed by a San Francisco–based company in which Mayo has an ongoing investment. The result of both initiatives, executives say, is energized physicians who are helping themselves and each other achieve healthcare's Triple Aim: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare.

Scott Mace, for HealthLeaders Media , November 25, 2014

A firsthand look at how a population takes on improving its population health.

The prospect of a bunch of healthcare investors investing in California's unhealthiest county as a business opportunity may strike you as a bit wacky.

But longtime readers of this column have seen this story unfolding as twice before I wrote about investor Esther Dyson's vision of lifting the health of an entire town through a combination of entrepreneurial spirit, a radical rethinking of healthcare, a dash of technology, and community organizing.

When I last visited Dyson's nonprofit startup, HICCup (for Health Initiative Coordinating Council), it had just put out its call for participants in a bold five-year experiment: Single out five communities of 100,000 population or less, then use those communities as hothouses of healthcare innovation, attracting investment capital and innovators to upend previous cultures of isolation and disease and replace them with cultures of cooperation and health.

The lifespan of Google Glass might just be short-lived, with the technology facing an increasing amount of public criticism in recent months. But does it fare a little better in healthcare? Industry stakeholders say, "yes."

A recent online newsletter listed Google Glass as among the top 10 tech failures in 2014. And among several other publications, Time opined that it doesn't see a future for the eyewear, adding that "most of us don't want to go around town looking like Star Trek's Geordi LaForge."

A majority of patients would be willing to share their healthcare information with researchers, employers, health plans, and their doctors, according to a Truven Health Analytics-NPR Health Poll.

More than 3,000 people responded to the survey, which included questions on information sharing, electronic medical records and privacy concerns.

More than two-thirds or 68 percent of the respondents said they would be OK with sharing health information anonymously with researchers. According to the survey's author, that number increases with level of education and income. Millennials, those 35 and younger, were the most likely to be willing to share information anonymously at about 70 percent.

Forthcoming legislation drafted by Sens. Orrin Hatch (R-Utah, pictured) and Michael Bennett (D-Colo.) looks to exempt electronic health records and clinical decision support software from oversight by the U.S. Food and Drug Administration.

The legislation--the Medical Electronic Data Technology Enhancement for Consumers' Health (MEDTECH) Act--outlines five areas of the Federal Food, Drug, and Cosmetic Act, in all, to be amended. The bill's language says that the following should not be deemed "devices within the meaning" of the earlier law:

Software intended for administrative or operational support of a healthcare facility

Products unrelated to clinical treatment of a disease or disorder

EHRs that "functionally represent a medical chart, including patient history records, but excluding diagnostic image data," as long as the EHR system is "validated prior to marketing"

Physicians will prescribe fewer brand name drugs and can curb health spending when an electronic health record (EHR) defaults to show the generics first, according to a research study.

The study, led by researchers at the Perelman School of Medicine, The Wharton School and the Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, is published in a recent issue of Annals of Internal Medicine. The researchers looked at four ambulatory clinics (two internal medicine and two family medicine) in the University of Pennsylvania Health System between June 2011 and September 2012 and evaluated the difference in prescribing behavior for three commonly prescribed classes of medications between family medicine and internal medicine physicians. They underwent an intervention where family docs were shown both brand name and generic medication options within the EHR medication prescriber portal, but internal medicine physicians were shown a different display of only the generic medication options.

When it comes to health records, how concerned are Americans about what happens to their personal information?

We asked in the latest NPR-Truven Health Analytics Health Poll. And, in a bit of surprise to me, the responses showed that, in general, worries don't run very high.

First, we learned that nearly three-quarters of people see doctors who use electronic medical records. So the chances are good that your medical information is being kept digitally and that it can be served up to lots of people inside your doctor's office and elsewhere.

Where Do Americans Stand on Health Privacy?

A survey of more than 3,000 Americans conducted in August with results released this month finds 5 percent of respondents have been notified that their medical records were breached. The highest rate of notifications—16 percent—was among respondents with an income above $100,000.

Truven Health Analytics and National Public Radio conducted the poll; the organizations do monthly polls on a variety of healthcare issues and the August poll focused on privacy issues. While more than two-thirds of respondents said they are willing to share health information anonymously with researchers, some worry about the privacy of their records that other stakeholders possess.

“Sixteen percent of respondents have privacy concerns regarding health records held by their health insurer,” according to a summary of survey results. “Fourteen percent have concerns about records held by their hospital, 11 percent with records held by their physician, and 10 percent with records held by their employer.”

By 2020, 80 percent of healthcare data will pass through the cloud at some point in its lifetime, as providers seek to leverage cloud based technologies and infrastructure for data collection, aggregation, analytics and decision-making. And, 65 percent of consumer transactions with healthcare organizations will be mobile by 2018.

Those are some of the near-term predictions for the healthcare industry by research firm IDC Health Insights. The predictions are meant to provide healthcare executives with a basic framework for evaluating and initiating IT initiatives—now and in the foreseeable future. Among IDC’s other predictions:

*With healthcare costs rising, operational inefficiency will become critical at 25 percent of hospitals resulting in the development of a data-driven digital hospital strategy requiring budgeting in 2016.

Reflecting on 2014, the health care landscape has become clearer in some regards and murkier in others. ICD-10 was once again delayed, and there's a lot of debate on whether the new date will stick. Many providers attested to Stage 1 meaningful use, but the timelines for stages 2 and 3 have come under serious scrutiny among large provider groups. Major shifts are still hanging in the balance. We are reminded of Medicare -- now a solid and beneficial institution -- and the alignment of politicians and physician groups against it. The implementation of diagnostic-related groups is another example of a seismic shift that is now well accepted.

These topics will certainly take center stage next year -- but what other changes do we have in store? After observing the health care industry for 40-plus years, here are some of my main predictions for 2015.

1. Care, Testing Will Progressively Move to Patients' Homes

Beyond the rise of telemedicine and telehealth -- which will certainly increase in popularity due to the growing provider shortage -- home testing devices will become increasingly popular, especially among patients with chronic conditions. With 75% of national health care spending going toward the treatment of chronic diseases (two-thirds of Medicare beneficiaries have at least two chronic conditions and they account for 93% of Medicare spending), a number of providers will start pushing for better and safer electronic data transfers.

Setting out a new IT strategy for the health service will be a key target for the HSE’s new chief information officer when he takes up his post next month, according to Minister for Health Leo Varadkar.

Richard Corbridge will join the HSE from the NHS National Institute for Health Research. Implementing the Government’s ehealth strategy will be among his responsibilities.

Ireland spends just 0.85 per cent of its health budget on IT, compared with an EU range of 2–3 per cent. Asked whether he would increase this to support the governance and delivery of the Government’s ehealth strategy, Varadkar said that once the new IT strategy for the HSE had been finalised, “we will have a clearer picture of the level of investment needed”.

1 comment:

David, the ability to detect unauthorised access to patient records is impossible without e-records. Institutions such as Beth Israel Deaconess have had this functionality since the late 1980s.1. Safran C, Porter D, Lightfoot J, Rury CD, Underhill LH, Bleich HL, et al. ClinQuery: a system for online searching of data in a teaching hospital. Ann Intern Med. 1989;111(9):751-6. Epub 1989/11/01.2. Safran C, Porter D, Rury CD, Herrmann FR, Lightfoot J, Underhill LH, et al. ClinQuery: searching a large clinical database. MD Comput. 1990;7(3):144-53. Epub 1990/05/01.Another study in the 90s revealed that 85% of unauthorised access to medical records was by doctors and nurses who had no rights of access. "The major vulnerabilities are related to inappropriate use of patient-specific information by health workers who have access to those data as part of their regular work. Such risks are greater when data are stored in paper charts.”“85% of unauthorized access to medical records is by hospital medical staff who have no rights of access to the medical record.”

(The evolution of health-care records in the era of the Internet.EH Shortliffe. Semi-Plenary. MEDINFO Seoul, August 1998) And from a Canadian study in 2006,“Many see the ‘insider’ threat – employees who have legitimate access to a network and the personal information it contains, but who choose to abuse this privilege – as the most dangerous security and privacy threat and the one that is the most difficult to defend against.” ~ Jennifer Stoddart, Privacy Commissioner of Canada, Infosecurity Canada Conference & Exhibition. Toronto, June 2006.